# Labor VR × immediate pain before analgesia: change signal and missing CI

Verdict 3004 · Evidence Check

Stored-material review date: Not recorded  
Original evidence cut-off: 2026-09-07  
Review-criteria version: 1.0  
Public page/material preparation date: 2026-10-19

Clinical papers were not read directly; existing review summaries were checked. No new clinical-literature search was performed. Unverified does not mean that research is absent or that there is no effect.

## Assessment scope

- Population: The key Wong trial involved 40 term nulliparous women before pharmacologic/neuraxial analgesia, with 21 VR and 19 control participants. Do not extend this to all laboring women, multiparous women, high-risk pregnancy, post-epidural use or all labor stages. Original eligibility, baseline pain, stages and endpoint/time-specific denominators are unverified.
- Ingredient, formulation and route: Immersive VR combined nature scenes, distraction and labor-specific audio guidance. This does not establish an isolated device/immersion effect or identical effects across headsets/content. Keep report-specific devices, content, contact and actual exposure conditions separate.
- Dose: Study exposures were up to 30 minutes in the key trial and about 10 minutes in the acute crossover. Do not turn key-trial exposure into post-exposure persistence or copy it to every report. Calculate no total exposure and create no VR setup, labor, analgesic or treatment instructions.
- Comparator: Original records use no added intervention and standard care, describing no active comparator to isolate attention effects. Non-VR contractions in the crossover and epidural status in other trials are separate. Shared care, guidance, contact, expectancy and exact original contrasts are unverified.
- Measured outcome: The selection is immediate pain before analgesia. Original Wong values are control +0.58, VR -0.52 and between-group change difference -1.10, P=.03; the direct 95% CI is unverified. MCID responses of 0% versus 23.8%, P=.049 are a separate record with unverified threshold validation and CI. Calculate no new change difference, CI or responder count.
- Duration: Up to 30 minutes is key-trial exposure. Distinguish another report’s during-use signal from nonpersistence 30 minutes later; exact time origins, concurrent analgesia and denominators are unverified. Do not transfer immediate score signals to sustained whole-labor effects or reduced medication/obstetric events.
- Questions outside this scope: Back-calculating CI/SE or standardized effects from original change differences/P, or calculating new MCID responder counts; Combining primary pain with secondary pain, satisfaction, anxiety or medication/obstetric events as one effect; Interchanging within-group reduction, pre/post-epidural and during/immediately-after/30-minutes-later results; Using representative populations, maximum exposure, standard care or total samples as every report/endpoint’s conditions or denominators; Counting same-cohort qualitative reports, shared bibliography or the three questions as new independent trials or participant totals; Certifying in-kind support, reported noninvolvement in analysis or public funding as complete independence/support verification; Inheriting parent C with 50 points, Caution or historical verification as subclaim scores or new clinical/safety certification; Creating new VR use/setup, labor, analgesic or treatment instructions, or medication/surgery replacement recommendations

## Checklist items

### N01 · Which immediate-pain claim is selected?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: The selection is immediate labor-pain reduction before pharmacologic analgesia. The original grade C note records a 40-person primary pain result and a brief signal from a small independent crossover. Persistence and analgesic/operative events are separate.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Materials are needed for populations, medication status, comparator, scale, timing, denominators and original effects/CIs. Create no new question or independence certification.
- Required materials and conditions: Subclaim of immediate labor pain before pharmacologic analgesia
- Materials to obtain first: Materials are needed for populations, medication status, comparator, scale, timing, denominators and original effects/CIs. Create no new question or independence certification.
- Further research: Material needed: Materials are needed for populations, medication status, comparator, scale, timing, denominators and original effects/CIs. Create no new question or independence certification. This records needed materials; no new research was executed.
- Conditions for verification: Material for Subclaim of immediate labor pain before pharmacologic analgesia must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Subclaim of immediate labor pain before pharmacologic analgesia with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01, R02, R03, R04

### N02 · What is Wong's between-group pain-change difference?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: Original results are control +0.58, VR -0.52 and between-group change difference -1.10, P=.03. The difference was already recorded; it was not calculated by subtracting arms now.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Original pain scale/direction, baseline/measurement windows, model, arm denominators, direct 95% CI and adjustment are unverified.
- Required materials and conditions: Direct between-group pre-post effects and original analysis
- Materials to obtain first: Original pain scale/direction, baseline/measurement windows, model, arm denominators, direct 95% CI and adjustment are unverified.
- Further research: Material needed: Original pain scale/direction, baseline/measurement windows, model, arm denominators, direct 95% CI and adjustment are unverified. This records needed materials; no new research was executed.
- Conditions for verification: Material for Direct between-group pre-post effects and original analysis must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Direct between-group pre-post effects and original analysis with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N03 · Were precision and importance of the original difference verified?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: The parent retains -1.10 points, P=.03 and an unverified 95% CI together. Do not turn this into a large or established whole-labor effect.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Original between-group intervals, variation/model, denominators, scales and patient-importance criteria are needed. Do not back-calculate CI, SE or standardized effects.
- Required materials and conditions: Original effect, direct interval and patient-important difference
- Materials to obtain first: Original between-group intervals, variation/model, denominators, scales and patient-importance criteria are needed. Do not back-calculate CI, SE or standardized effects.
- Further research: Material needed: Original between-group intervals, variation/model, denominators, scales and patient-importance criteria are needed. Do not back-calculate CI, SE or standardized effects. This records needed materials; no new research was executed.
- Conditions for verification: Material for Original effect, direct interval and patient-important difference must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Original effect, direct interval and patient-important difference with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N04 · What do allocation and all analyzed mean?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: Wong records 40 participants, 21 VR/19 control, and the text says all 40 were analyzed. This does not establish complete data for every endpoint, time or harm, or adequate power.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Original flow, missingness/stopping, endpoint/time-specific denominators, ITT/analysis definitions and harm exposure are needed. Calculate no new arm data or events.
- Required materials and conditions: Allocation, analysis and endpoint/time-specific data/exposure denominators
- Materials to obtain first: Original flow, missingness/stopping, endpoint/time-specific denominators, ITT/analysis definitions and harm exposure are needed. Calculate no new arm data or events.
- Further research: Material needed: Original flow, missingness/stopping, endpoint/time-specific denominators, ITT/analysis definitions and harm exposure are needed. Calculate no new arm data or events. This records needed materials; no new research was executed.
- Conditions for verification: Material for Allocation, analysis and endpoint/time-specific data/exposure denominators must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Allocation, analysis and endpoint/time-specific data/exposure denominators with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N05 · Who was studied before pharmacologic or neuraxial analgesia?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: The parent describes 40 term nulliparous women before pharmacologic/neuraxial analgesia in the key trial. Do not copy effects to all laboring women, post-epidural use or other labor stages.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Original pregnancy/labor stages, baseline pain, parity/term status, analgesia/cointerventions, high-risk/exclusion criteria and denominators are unverified.
- Required materials and conditions: Term/nulliparous eligibility, labor status and pre-analgesia scope
- Materials to obtain first: Original pregnancy/labor stages, baseline pain, parity/term status, analgesia/cointerventions, high-risk/exclusion criteria and denominators are unverified.
- Further research: Material needed: Original pregnancy/labor stages, baseline pain, parity/term status, analgesia/cointerventions, high-risk/exclusion criteria and denominators are unverified. This records needed materials; no new research was executed.
- Conditions for verification: Material for Term/nulliparous eligibility, labor status and pre-analgesia scope must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Term/nulliparous eligibility, labor status and pre-analgesia scope with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N06 · Were nature scenes, audio and distraction separated?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: The key trial combined nature scenes, distraction and labor-specific audio. Do not establish an isolated device/immersion effect or identical effects across all content.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Materials distinguishing devices, content, audio/contact, exposure and comparator components, including active controls, are needed. Create no new VR setup, labor or analgesia instructions.
- Required materials and conditions: Attribution of combined content and immersive devices
- Materials to obtain first: Materials distinguishing devices, content, audio/contact, exposure and comparator components, including active controls, are needed. Create no new VR setup, labor or analgesia instructions.
- Further research: Material needed: Materials distinguishing devices, content, audio/contact, exposure and comparator components, including active controls, are needed. Create no new VR setup, labor or analgesia instructions. This records needed materials; no new research was executed.
- Conditions for verification: Material for Attribution of combined content and immersive devices must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Attribution of combined content and immersive devices with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N07 · Are original and active attention controls the same?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: Original records describe up to 30 minutes of VR versus no added intervention and standard care. They describe no active control to isolate attention effects.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Shared care, contact/guidance, active attention controls, expectancy/blinding, exact original contrasts and denominators are unverified.
- Required materials and conditions: Original comparator versus attention, contact and expectancy
- Materials to obtain first: Shared care, contact/guidance, active attention controls, expectancy/blinding, exact original contrasts and denominators are unverified.
- Further research: Material needed: Shared care, contact/guidance, active attention controls, expectancy/blinding, exact original contrasts and denominators are unverified. This records needed materials; no new research was executed.
- Conditions for verification: Material for Original comparator versus attention, contact and expectancy must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Original comparator versus attention, contact and expectancy with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N08 · What are pain and anxiety in the Frey crossover?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: Frey records an order-randomized acute crossover of 27 participants, about 10 minutes of VR/non-VR contractions. Distinguish sensory pain -1.5 (95% CI -2.2 to -0.8) from anxiety -1.5 (-2.3 to -0.8).
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Original scales, contraction/assessment windows, order/periods/carryover, paired denominators, crossover estimation and hierarchy are unverified. Do not convert scales or newly assign an interval level to anxiety.
- Required materials and conditions: Separate acute crossover endpoints, intervals and analysis
- Materials to obtain first: Original scales, contraction/assessment windows, order/periods/carryover, paired denominators, crossover estimation and hierarchy are unverified. Do not convert scales or newly assign an interval level to anxiety.
- Further research: Material needed: Original scales, contraction/assessment windows, order/periods/carryover, paired denominators, crossover estimation and hierarchy are unverified. Do not convert scales or newly assign an interval level to anxiety. This records needed materials; no new research was executed.
- Conditions for verification: Material for Separate acute crossover endpoints, intervals and analysis must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Separate acute crossover endpoints, intervals and analysis with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R02

### N09 · Is crossover support replication under identical conditions?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: The parent distinguishes brief pain/anxiety signals from an independent acute crossover with different content/scales. Do not count repeated contractions as new participants or combine them as the same effect as the key trial's -1.10 points.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Links among institutions, recruitment, registration/support, content/scales, order/carryover, paired denominators and original effects/CIs are needed. Create no new independence certification or totals.
- Required materials and conditions: Content, scales, within-person correlation and independence wording
- Materials to obtain first: Links among institutions, recruitment, registration/support, content/scales, order/carryover, paired denominators and original effects/CIs are needed. Create no new independence certification or totals.
- Further research: Material needed: Links among institutions, recruitment, registration/support, content/scales, order/carryover, paired denominators and original effects/CIs are needed. Create no new independence certification or totals. This records needed materials; no new research was executed.
- Conditions for verification: Material for Content, scales, within-person correlation and independence wording must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Content, scales, within-person correlation and independence wording with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01, R02

### N10 · Are MCID responses separate confirmation?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: The parent retains minimum-clinically-important-difference responses of 0% versus 23.8%, P=.049 with unverified external threshold validation and CI, without adding another strength.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Criterion source/prespecification, arm order, responders/denominators, direct effects/CIs and multiplicity are needed. Calculate no new responder counts from allocation sizes.
- Required materials and conditions: Response criteria, denominators, external validation and intervals
- Materials to obtain first: Criterion source/prespecification, arm order, responders/denominators, direct effects/CIs and multiplicity are needed. Calculate no new responder counts from allocation sizes.
- Further research: Material needed: Criterion source/prespecification, arm order, responders/denominators, direct effects/CIs and multiplicity are needed. Calculate no new responder counts from allocation sizes. This records needed materials; no new research was executed.
- Conditions for verification: Material for Response criteria, denominators, external validation and intervals must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Response criteria, denominators, external validation and intervals with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N11 · Are Carus satisfaction and pain distinguished?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: Carus records 42 participants, 21 versus 21, primary satisfaction P=.04 and secondary pain. Early within-group pain reduction and no post-epidural change are separate findings.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Do not turn satisfaction P or within-group pain into direct between-group primary pain effects. Original scales, time-specific denominators, medication status, between-group effects/CIs and hierarchy are needed.
- Required materials and conditions: Primary satisfaction, secondary pain and pre/post-epidural results
- Materials to obtain first: Do not turn satisfaction P or within-group pain into direct between-group primary pain effects. Original scales, time-specific denominators, medication status, between-group effects/CIs and hierarchy are needed.
- Further research: Material needed: Do not turn satisfaction P or within-group pain into direct between-group primary pain effects. Original scales, time-specific denominators, medication status, between-group effects/CIs and hierarchy are needed. This records needed materials; no new research was executed.
- Conditions for verification: Material for Primary satisfaction, secondary pain and pre/post-epidural results must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Primary satisfaction, secondary pain and pre/post-epidural results with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R03

### N12 · Are immediate signals transferred to persistent effects?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: Up to 30 minutes is key-trial exposure. Correia records that the during-use signal was not maintained 30 minutes later. Do not turn immediate/during-use findings into persistent effects.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Time origins for exposure end, baseline/during/immediate/follow-up, original between-group effects/CIs, denominators and concurrent analgesia are unverified.
- Required materials and conditions: Exposure duration versus during, immediate and post-exposure assessment
- Materials to obtain first: Time origins for exposure end, baseline/during/immediate/follow-up, original between-group effects/CIs, denominators and concurrent analgesia are unverified.
- Further research: Material needed: Time origins for exposure end, baseline/during/immediate/follow-up, original between-group effects/CIs, denominators and concurrent analgesia are unverified. This records needed materials; no new research was executed.
- Conditions for verification: Material for Exposure duration versus during, immediate and post-exposure assessment must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Exposure duration versus during, immediate and post-exposure assessment with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01, R04

### N13 · Does a pain signal mean less analgesia or operative birth?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: The original text and separate event subclaim describe unestablished precise effects and power for analgesic/obstetric events. Do not turn pain/satisfaction signals into confirmation of medication replacement or surgery prevention.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Original event definitions, medication/timing, denominators, direct effects/CIs, prespecified sample/power and clinical plans are needed. Create no new labor or analgesia instructions.
- Required materials and conditions: Subjective pain versus epidural, cesarean and instrumental-delivery events
- Materials to obtain first: Original event definitions, medication/timing, denominators, direct effects/CIs, prespecified sample/power and clinical plans are needed. Create no new labor or analgesia instructions.
- Further research: Material needed: Original event definitions, medication/timing, denominators, direct effects/CIs, prespecified sample/power and clinical plans are needed. Create no new labor or analgesia instructions. This records needed materials; no new research was executed.
- Conditions for verification: Material for Subjective pain versus epidural, cesarean and instrumental-delivery events must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Subjective pain versus epidural, cesarean and instrumental-delivery events with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01, R02, R03, R04

### N14 · Are brief self-report and unblinded limitations retained?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: The key trial is open randomized; the text retains patient-reported, small acute unblinded-trial limitations. A primary signal does not resolve every bias or selection issue.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Allocation/concealment, assessors/participants, measurement/baseline adjustment, prespecified endpoints/registration/plans, missingness and selected times are unverified. Create no new formal bias assessment or grade.
- Required materials and conditions: Pain measurement, expectancy, prespecified endpoints and selective reporting
- Materials to obtain first: Allocation/concealment, assessors/participants, measurement/baseline adjustment, prespecified endpoints/registration/plans, missingness and selected times are unverified. Create no new formal bias assessment or grade.
- Further research: Material needed: Allocation/concealment, assessors/participants, measurement/baseline adjustment, prespecified endpoints/registration/plans, missingness and selected times are unverified. Create no new formal bias assessment or grade. This records needed materials; no new research was executed.
- Conditions for verification: Material for Pain measurement, expectancy, prespecified endpoints and selective reporting must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Pain measurement, expectancy, prespecified endpoints and selective reporting with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N15 · Are brief pain and maternal/neonatal harms separated?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: The parent describes dizziness, motion sickness, discomfort/visual obstruction and monitoring/communication boundaries, noting that 40 participants are too few for rare maternal/neonatal harms.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Original harm counts, denominators, active collection, severity/timing, stopping/cointerventions and vulnerable-population data are needed. Absence of numbers does not establish safety or justify new use/treatment instructions.
- Required materials and conditions: Harms collection, events, denominators, timing and observation conditions
- Materials to obtain first: Original harm counts, denominators, active collection, severity/timing, stopping/cointerventions and vulnerable-population data are needed. Absence of numbers does not establish safety or justify new use/treatment instructions.
- Further research: Material needed: Original harm counts, denominators, active collection, severity/timing, stopping/cointerventions and vulnerable-population data are needed. Absence of numbers does not establish safety or justify new use/treatment instructions. This records needed materials; no new research was executed.
- Conditions for verification: Material for Harms collection, events, denominators, timing and observation conditions must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Harms collection, events, denominators, timing and observation conditions with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01, R02, R03, R04

### N16 · What is the scope of AppliedVR support and analysis noninvolvement?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: Wong's funding wording preserves AppliedVR device/software in-kind support and reported noninvolvement in analysis in a same-cohort report. Do not add a same-cohort qualitative study as a new trial.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Money/in-kind support, author affiliations/COI, design/analysis/publication roles and same-cohort original-report identification are needed. Do not extend reported analysis noninvolvement to every role.
- Required materials and conditions: Same-cohort product support and analysis roles
- Materials to obtain first: Money/in-kind support, author affiliations/COI, design/analysis/publication roles and same-cohort original-report identification are needed. Do not extend reported analysis noninvolvement to every role.
- Further research: Material needed: Money/in-kind support, author affiliations/COI, design/analysis/publication roles and same-cohort original-report identification are needed. Do not extend reported analysis noninvolvement to every role. This records needed materials; no new research was executed.
- Conditions for verification: Material for Same-cohort product support and analysis roles must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Same-cohort product support and analysis roles with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N17 · What are funding and COI in other reports?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: Preserve Frey's NIH AR054115 and GM042725, Carus's reported no applicable funding/no conflicts and Correia's unverified support.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Original money, device support, affiliations/COI, design/analysis/publication roles and company relationships are unverified. Do not promote these to complete support verification.
- Required materials and conditions: Public funding, no-funding declarations, unverified support and company roles
- Materials to obtain first: Original money, device support, affiliations/COI, design/analysis/publication roles and company relationships are unverified. Do not promote these to complete support verification.
- Further research: Material needed: Original money, device support, affiliations/COI, design/analysis/publication roles and company relationships are unverified. Do not promote these to complete support verification. This records needed materials; no new research was executed.
- Conditions for verification: Material for Public funding, no-funding declarations, unverified support and company roles must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Public funding, no-funding declarations, unverified support and company roles with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R02, R03, R04

### N18 · Do identifiers verify prespecified hierarchy?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: Preserve unverified Wong paper–official-registration linkage, Frey NCT02926469, Carus NCT05032456 and unverified Correia registration. Identifiers/PMCID do not establish current reading or prospective prespecification.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Original registration/change history, protocols/SAPs, paper linkage and prespecified endpoints/denominators/success rules are needed. Infer no new URLs and perform no clinical link checks.
- Required materials and conditions: Paper-registration linkage, original identifiers and registration/plan reading
- Materials to obtain first: Original registration/change history, protocols/SAPs, paper linkage and prespecified endpoints/denominators/success rules are needed. Infer no new URLs and perform no clinical link checks.
- Further research: Material needed: Original registration/change history, protocols/SAPs, paper linkage and prespecified endpoints/denominators/success rules are needed. Infer no new URLs and perform no clinical link checks. This records needed materials; no new research was executed.
- Conditions for verification: Material for Paper-registration linkage, original identifiers and registration/plan reading must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Paper-registration linkage, original identifiers and registration/plan reading with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01, R02, R03, R04

### N19 · Can shared reports be counted as new independent trials?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: The parent and three subclaims share four reports. Preserve the original rule against counting same-cohort qualitative material as replication.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Registration, institutions, recruitment, participants, reports/support and qualitative/quantitative cohort relationships are needed. Do not sum reports, years or sheets as new unique-trial/participant totals.
- Required materials and conditions: Parent/subclaims and same-cohort report relationships
- Materials to obtain first: Registration, institutions, recruitment, participants, reports/support and qualitative/quantitative cohort relationships are needed. Do not sum reports, years or sheets as new unique-trial/participant totals.
- Further research: Material needed: Registration, institutions, recruitment, participants, reports/support and qualitative/quantitative cohort relationships are needed. Do not sum reports, years or sheets as new unique-trial/participant totals. This records needed materials; no new research was executed.
- Conditions for verification: Material for Parent/subclaims and same-cohort report relationships must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Parent/subclaims and same-cohort report relationships with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01, R02, R03, R04

### N20 · Are total samples every endpoint's denominators?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: Preserve original sizes separately: 40 participants (21/19), 27, 42 (21/21) and 61 (32/29). Identical crossover, satisfaction, pain, medication, event, time and harm denominators have not been verified.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: All analyzed is key-trial context and is not copied to other reports. Original flow, missingness/stopping, cointerventions, analysis populations and sensitivity are needed; calculate no new totals, rates, responder counts or effects.
- Required materials and conditions: Report-specific allocation, analysis and endpoint/time denominators
- Materials to obtain first: All analyzed is key-trial context and is not copied to other reports. Original flow, missingness/stopping, cointerventions, analysis populations and sensitivity are needed; calculate no new totals, rates, responder counts or effects.
- Further research: Material needed: All analyzed is key-trial context and is not copied to other reports. Original flow, missingness/stopping, cointerventions, analysis populations and sensitivity are needed; calculate no new totals, rates, responder counts or effects. This records needed materials; no new research was executed.
- Conditions for verification: Material for Report-specific allocation, analysis and endpoint/time denominators must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Report-specific allocation, analysis and endpoint/time denominators with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01, R02, R03, R04

### N21 · Are research records turned into use or analgesia instructions?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: This work preserves devices, content, comparisons and safety boundaries in an evidence table. Create no new VR use/setup steps, labor, analgesic or treatment instructions, or replacement guidance.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Actual treatment/use decisions are separate. Create no methods or medication-change recommendations beyond the original text.
- Required materials and conditions: Original exposure/safety wording versus operational guidance
- Materials to obtain first: Actual treatment/use decisions are separate. Create no methods or medication-change recommendations beyond the original text.
- Further research: Material needed: Actual treatment/use decisions are separate. Create no methods or medication-change recommendations beyond the original text. This records needed materials; no new research was executed.
- Conditions for verification: Material for Original exposure/safety wording versus operational guidance must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Original exposure/safety wording versus operational guidance with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01, R02, R03, R04

### N22 · Are subclaim grades distinguished from parent scores and axes?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: Preserve immediate-pain C, persistence D and event ?. Subclaim scores/status/axes are absent; parent C with 50 points, Caution, original axes and unrecorded precision concern immediate-pain context.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Do not fill absent subclaim fields from parent values or turn unrecorded/? into definite values. Create no new grades, scores or independence certification.
- Required materials and conditions: Subclaim grades, absent score/status/axes and parent context
- Materials to obtain first: Do not fill absent subclaim fields from parent values or turn unrecorded/? into definite values. Create no new grades, scores or independence certification.
- Further research: Material needed: Do not fill absent subclaim fields from parent values or turn unrecorded/? into definite values. Create no new grades, scores or independence certification. This records needed materials; no new research was executed.
- Conditions for verification: Material for Subclaim grades, absent score/status/axes and parent context must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Subclaim grades, absent score/status/axes and parent context with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01, R02, R03, R04

### N23 · Are representative conditions copied to every report?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: Preserve parent bilingual text and representative conditions. Do not apply 40 participants, up to 30 minutes, standard care or pre-post differences as identical conditions for the 27-person crossover, 42-person satisfaction trial or 61-person persistence trial.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Original report-specific populations, devices/content, comparators, denominators, endpoints/times and English correspondence are needed. No external English comparison or clinical correction review was performed now.
- Required materials and conditions: Both languages, devices/content, population, timing and denominators
- Materials to obtain first: Original report-specific populations, devices/content, comparators, denominators, endpoints/times and English correspondence are needed. No external English comparison or clinical correction review was performed now.
- Further research: Material needed: Original report-specific populations, devices/content, comparators, denominators, endpoints/times and English correspondence are needed. No external English comparison or clinical correction review was performed now. This records needed materials; no new research was executed.
- Conditions for verification: Material for Both languages, devices/content, population, timing and denominators must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Both languages, devices/content, population, timing and denominators with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01, R02, R03, R04

### N24 · Are stored-summary and external-material reading distinguished?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: The complete stored parent summary was read for production. Historical verification, incorporation, cross-checks and same-cohort support wording are retained as history; external abstracts, full texts, registration and protocols/SAPs are unread.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: URLs, PMCID or identifiers do not establish acquisition, accessibility, reading or completed review. Actual material acquisition and review are separate events.
- Required materials and conditions: Material-specific existence, acquisition and actual reading
- Materials to obtain first: URLs, PMCID or identifiers do not establish acquisition, accessibility, reading or completed review. Actual material acquisition and review are separate events.
- Further research: Material needed: URLs, PMCID or identifiers do not establish acquisition, accessibility, reading or completed review. Actual material acquisition and review are separate events. This records needed materials; no new research was executed.
- Conditions for verification: Material for Material-specific existence, acquisition and actual reading must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Material-specific existence, acquisition and actual reading with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01, R02, R03, R04

### N25 · How are evidence date, empty histories and production date distinguished?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: Preserve original evidence date 2026-09-07, empty corrections and empty deliberation. Retain the original 2026 report bibliography and periods; production date does not become a new evidence-verification date.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Link complete originals, versions and events when new material/corrections are obtained. No new external lookup or original-verdict change was performed.
- Required materials and conditions: Original evidence date, correction/deliberation records and date roles
- Materials to obtain first: Link complete originals, versions and events when new material/corrections are obtained. No new external lookup or original-verdict change was performed.
- Further research: Material needed: Link complete originals, versions and events when new material/corrections are obtained. No new external lookup or original-verdict change was performed. This records needed materials; no new research was executed.
- Conditions for verification: Material for Original evidence date, correction/deliberation records and date roles must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Original evidence date, correction/deliberation records and date roles with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01, R02, R03, R04

### N26 · Are material slots quality or independent-trial counts?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: The 20 material slots comprise 4 stored summaries and 16 unread external slots. They are not acquired papers, unique trials, participants, independent replications or quality scores.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Do not double-count sharing across parent/subclaims. Distinguish original trials/cohorts and actual acquisition/reading; unique-trial/participant totals remain unverified.
- Required materials and conditions: Production structure versus unique clinical units and actual acquisition
- Materials to obtain first: Do not double-count sharing across parent/subclaims. Distinguish original trials/cohorts and actual acquisition/reading; unique-trial/participant totals remain unverified.
- Further research: Material needed: Do not double-count sharing across parent/subclaims. Distinguish original trials/cohorts and actual acquisition/reading; unique-trial/participant totals remain unverified. This records needed materials; no new research was executed.
- Conditions for verification: Material for Production structure versus unique clinical units and actual acquisition must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Production structure versus unique clinical units and actual acquisition with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01, R02, R03, R04

### N27 · How are new materials or changed questions updated?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: Preserve original material and production conditions/observations. Link additions or question changes to relevant comparisons, denominators, endpoints/times, reports and subclaim boundaries; no new lookup, calculation or regrading occurred now.
- Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
- Reason for missing information: Record complete originals, criterion versions, events and reasons for change. Do not invent effects, CIs, independence or VR, labor, analgesic or treatment instructions.
- Required materials and conditions: Separating criteria revisions, evidence updates and verdict-change events
- Materials to obtain first: Record complete originals, criterion versions, events and reasons for change. Do not invent effects, CIs, independence or VR, labor, analgesic or treatment instructions.
- Further research: Material needed: Record complete originals, criterion versions, events and reasons for change. Do not invent effects, CIs, independence or VR, labor, analgesic or treatment instructions. This records needed materials; no new research was executed.
- Conditions for verification: Material for Separating criteria revisions, evidence updates and verdict-change events must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
- Why this condition is needed: This condition connects Separating criteria revisions, evidence updates and verdict-change events with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.
- Application exceptions: Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.
- Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01, R02, R03, R04

## Evidence and sources

### R01

Wong MS, Spiegel BMR, Gregory KD. Virtual Reality Reduces Pain in Laboring Women: A Randomized Controlled Trial. Am J Perinatol. 2021;38(S01):e167-e172. PMID: 32485759. DOI: 10.1055/s-0040-1708851.

[PubMed](https://pubmed.ncbi.nlm.nih.gov/32485759/)

Materials actually read: Stored summary read; external materials unread  
Findings recorded in the summary: Control +0.58, VR -0.52; difference in change -1.10, P=.03  
Record level: Primary between-group pre-post pain change from 40 participants, 21 VR/19 control. Direct intervals, scales/models and endpoint-specific denominators are unverified. All analyzed and MCID-response statements do not establish complete data at all times/for harms or separate confirmation.  
Independent replication: The parent and three subclaims share the four Wong, Frey, Carus and Correia references. Preserve the original rule against adding same-cohort qualitative material as replication. Do not count reports, years, repeated contractions or separate sheets as new unique trials or independent participant totals; unique-trial/participant totals are unverified.

| Material | Public availability | Access status | Actually read | Notes |
|---|---|---|---|---|
| Stored existing review summary | Preserved copy of the complete parent-verdict stored summary | Stored summary | Summary read | Preserve original PMID 32485759, DOI 10.1055/s-0040-1708851 and unverified paper–official-registration linkage. PMCID and case/citation registration annotations are unrecorded. Same-cohort in-kind-support/noninvolvement-in-analysis statements do not become new reading or independence certification. |
| External abstract | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PMID 32485759, DOI 10.1055/s-0040-1708851 and unverified paper–official-registration linkage. PMCID and case/citation registration annotations are unrecorded. Same-cohort in-kind-support/noninvolvement-in-analysis statements do not become new reading or independence certification. |
| External full text | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PMID 32485759, DOI 10.1055/s-0040-1708851 and unverified paper–official-registration linkage. PMCID and case/citation registration annotations are unrecorded. Same-cohort in-kind-support/noninvolvement-in-analysis statements do not become new reading or independence certification. |
| Registration material | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PMID 32485759, DOI 10.1055/s-0040-1708851 and unverified paper–official-registration linkage. PMCID and case/citation registration annotations are unrecorded. Same-cohort in-kind-support/noninvolvement-in-analysis statements do not become new reading or independence certification. |
| Protocol and analysis plan | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PMID 32485759, DOI 10.1055/s-0040-1708851 and unverified paper–official-registration linkage. PMCID and case/citation registration annotations are unrecorded. Same-cohort in-kind-support/noninvolvement-in-analysis statements do not become new reading or independence certification. |

### R02

Frey DP, et al. Virtual Reality Analgesia in Labor: The VRAIL Pilot Study-A Preliminary Randomized Controlled Trial Suggesting Benefit of Immersive Virtual Reality Analgesia in Unmedicated Laboring Women. Anesth Analg. 2019;128:e93-e96. PMID: 31094789. DOI: 10.1213/ANE.0000000000003649.

[PubMed](https://pubmed.ncbi.nlm.nih.gov/31094789/)

Materials actually read: Stored summary read; external materials unread  
Findings recorded in the summary: Sensory pain -1.5 (95% CI -2.2 to -0.8); anxiety -1.5 (-2.3 to -0.8)  
Record level: Order-randomized acute crossover context with 27 participants. Keep original sensory-pain and anxiety values separate without newly assigning an interval level to anxiety. Order, periods, carryover, paired denominators and differing content/scales are unverified.  
Independent replication: The parent and three subclaims share the four Wong, Frey, Carus and Correia references. Preserve the original rule against adding same-cohort qualitative material as replication. Do not count reports, years, repeated contractions or separate sheets as new unique trials or independent participant totals; unique-trial/participant totals are unverified.

| Material | Public availability | Access status | Actually read | Notes |
|---|---|---|---|---|
| Stored existing review summary | Preserved copy of the complete parent-verdict stored summary | Stored summary | Summary read | Preserve original PMID 31094789, DOI 10.1213/ANE.0000000000003649 and NCT02926469. PMCID is unrecorded. The identifier and original funding wording do not establish current registration/full-text reading, prospective status or complete support verification. |
| External abstract | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PMID 31094789, DOI 10.1213/ANE.0000000000003649 and NCT02926469. PMCID is unrecorded. The identifier and original funding wording do not establish current registration/full-text reading, prospective status or complete support verification. |
| External full text | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PMID 31094789, DOI 10.1213/ANE.0000000000003649 and NCT02926469. PMCID is unrecorded. The identifier and original funding wording do not establish current registration/full-text reading, prospective status or complete support verification. |
| Registration material | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PMID 31094789, DOI 10.1213/ANE.0000000000003649 and NCT02926469. PMCID is unrecorded. The identifier and original funding wording do not establish current registration/full-text reading, prospective status or complete support verification. |
| Protocol and analysis plan | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PMID 31094789, DOI 10.1213/ANE.0000000000003649 and NCT02926469. PMCID is unrecorded. The identifier and original funding wording do not establish current registration/full-text reading, prospective status or complete support verification. |

### R03

Carus EG, Albayrak N, Bildirici HM, Gur Ozmen S. Immersive virtual reality on childbirth experience for women: a randomized controlled trial. BMC Pregnancy Childbirth. 2022;22:354. PMID: 35461248. PMCID: PMC9034564. DOI: 10.1186/s12884-022-04598-y.

[PubMed](https://pubmed.ncbi.nlm.nih.gov/35461248/)

Materials actually read: Stored summary read; external materials unread  
Findings recorded in the summary: Satisfaction P=.04; within-group early-pain reduction and no post-epidural change  
Record level: 42 participants, 21 versus 21, distinguishing primary satisfaction from secondary pain. Do not turn early within-group reduction or no post-epidural change into a direct between-group primary pain effect. Exact intervals, time-specific denominators and medication status are unverified.  
Independent replication: The parent and three subclaims share the four Wong, Frey, Carus and Correia references. Preserve the original rule against adding same-cohort qualitative material as replication. Do not count reports, years, repeated contractions or separate sheets as new unique trials or independent participant totals; unique-trial/participant totals are unverified.

| Material | Public availability | Access status | Actually read | Notes |
|---|---|---|---|---|
| Stored existing review summary | Preserved copy of the complete parent-verdict stored summary | Stored summary | Summary read | Preserve original PMID 35461248, PMCID PMC9034564, DOI 10.1186/s12884-022-04598-y and NCT05032456. The citation registration annotation is unrecorded, separately from the case annotation. Identifiers/PMCID do not establish current reading or prospective status. |
| External abstract | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PMID 35461248, PMCID PMC9034564, DOI 10.1186/s12884-022-04598-y and NCT05032456. The citation registration annotation is unrecorded, separately from the case annotation. Identifiers/PMCID do not establish current reading or prospective status. |
| External full text | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PMID 35461248, PMCID PMC9034564, DOI 10.1186/s12884-022-04598-y and NCT05032456. The citation registration annotation is unrecorded, separately from the case annotation. Identifiers/PMCID do not establish current reading or prospective status. |
| Registration material | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PMID 35461248, PMCID PMC9034564, DOI 10.1186/s12884-022-04598-y and NCT05032456. The citation registration annotation is unrecorded, separately from the case annotation. Identifiers/PMCID do not establish current reading or prospective status. |
| Protocol and analysis plan | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PMID 35461248, PMCID PMC9034564, DOI 10.1186/s12884-022-04598-y and NCT05032456. The citation registration annotation is unrecorded, separately from the case annotation. Identifiers/PMCID do not establish current reading or prospective status. |

### R04

Correia MCG, et al. Virtual Reality in Labor Pain Management: A Randomized Controlled Trial. Pain Manag Nurs. 2026;27:e708-e714. PMID: 41896140. DOI: 10.1016/j.pmn.2026.02.005.

[PubMed](https://pubmed.ncbi.nlm.nih.gov/41896140/)

Materials actually read: Stored summary read; external materials unread  
Findings recorded in the summary: The during-use signal was not sustained 30 minutes later  
Record level: During-use and 30-minutes-later results from 61 participants, 32 versus 29. Nonpersistence does not establish exact effect 0 or equivalence. Exact effects/CIs, time origins, denominators, registration and support are unverified.  
Independent replication: The parent and three subclaims share the four Wong, Frey, Carus and Correia references. Preserve the original rule against adding same-cohort qualitative material as replication. Do not count reports, years, repeated contractions or separate sheets as new unique trials or independent participant totals; unique-trial/participant totals are unverified.

| Material | Public availability | Access status | Actually read | Notes |
|---|---|---|---|---|
| Stored existing review summary | Preserved copy of the complete parent-verdict stored summary | Stored summary | Summary read | Preserve original PMID 41896140, DOI 10.1016/j.pmn.2026.02.005 and unverified registration/support. PMCID and case/citation registration annotations are unrecorded. Retain the original bibliographic year and evidence date; infer no new URLs or original-material acquisition. |
| External abstract | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PMID 41896140, DOI 10.1016/j.pmn.2026.02.005 and unverified registration/support. PMCID and case/citation registration annotations are unrecorded. Retain the original bibliographic year and evidence date; infer no new URLs or original-material acquisition. |
| External full text | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PMID 41896140, DOI 10.1016/j.pmn.2026.02.005 and unverified registration/support. PMCID and case/citation registration annotations are unrecorded. Retain the original bibliographic year and evidence date; infer no new URLs or original-material acquisition. |
| Registration material | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PMID 41896140, DOI 10.1016/j.pmn.2026.02.005 and unverified registration/support. PMCID and case/citation registration annotations are unrecorded. Retain the original bibliographic year and evidence date; infer no new URLs or original-material acquisition. |
| Protocol and analysis plan | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PMID 41896140, DOI 10.1016/j.pmn.2026.02.005 and unverified registration/support. PMCID and case/citation registration annotations are unrecorded. Retain the original bibliographic year and evidence date; infer no new URLs or original-material acquisition. |

## Review criteria and methods

These are Chamgap's own application conditions, informed by the relevant sections of official methodological guidance. They do not constitute official assessment-tool certification or a new efficacy score.

- M03 [Cochrane Handbook 6.5 (2024), chapter updated 2023-08](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-03) · §3.1, §3.2.1–3.2.3, MECIR C5/C7/C13 · Clearly record the question, eligibility conditions and reasons for changes, and distinguish variations in interventions. · Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed.
- M04 [Cochrane Handbook 6.5.1 (2025), chapter updated 2025-03](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-04) · §4.5, §4.6.1–4.6.3, MECIR C42 · Distinguish studies from reports and link them; do not omit a study solely because results are unreported. · Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed.
- M08 [Cochrane Handbook 6.5 (2024), chapter updated 2019-10](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-08) · §8.1–8.2.3, Table 8.2.a · Define the outcome and effect of interest, then examine randomization, deviations, missing data, measurement and selective reporting. · Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed.
- M15 [Cochrane Handbook 6.5 (2024), chapter updated 2023-08](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-15) · §15.2.4, §15.3.1–15.3.3 · Distinguish effect estimates, intervals, importance and applicability. Sample size alone does not determine precision. · Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed.
- M19 [Cochrane Handbook 6.5 (2024), chapter updated 2019-10](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-19) · §19.1.2, §19.2.1–19.2.4 · Harm questions may require different designs, populations and follow-up from efficacy questions. Case reports do not establish incidence rates. · Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed.

## What the statuses mean

- Partly verified: Some information is present in the stored source, with detailed original materials still unverified; this does not mean review passed or clinical efficacy certified
- Unverified: Detailed materials for the selected condition could not be established within the stored scope; this does not mean zero effect, zero studies or safety
- Review incomplete: Awaiting user review
- Met: Use only within the relevant condition's scope after user review; no automatic display in this preparation
- Not reported: Distinguish only within materials actually read; do not turn unread external materials into unreported findings
- Inaccessible: Not applied during this preparation because actual access was not tested
- Not applicable: Use with a reason for non-applicability based on an explicit question boundary
- Conflicting data: Judge after actual material comparison; review was not performed during this preparation
- Insufficient evidence for the conditions: Do not use as a clinical grade encompassing currently unread materials

## Change history

2026-10-19 · Public page/materials 1.0. Public pages and materials were prepared from the existing 27 items. No new clinical search, verification-status change or scoring was performed.